Policy Text
SACRAMENTO POLICE DEPARTMENT
GENERAL ORDERS
GO 254.01
Page 1 of 2
254.01
REPORTING ON -DUTY INJURIES
02-02-2024
PURPOSE
The purpose of this general order is t o establish procedures for reporting on- duty injuries and securing
treatment for injured employees.
POLICY
It shall be the policy of t he Sacramento Police Department (SPD) to document all on-duty injuries and illnesses
and secure medical treatment for injured empl oyees in accordance with federal and/or state laws.
PROCEDURE
A. DEFINITIONS
1. ON-DUTY INJURY - An injury or illness resulting from an event or exposure that occurs while an
employee is acting in the course and scope of their employment .
2. PERSONAL PHYSICIAN - a licensed medical doctor who has previously directed the treatment of and
who retains the employee's medical records and history, within a reasonable geographic area of the
City of Sacramento.
B. GENERAL
1. The City's policy is to not accept liability for the payment of any medical treatment provided to
employees other than as outlined in this order. When a situation arises that is not covered by this order,
supervisors should contact the Personnel Services Division (PSD) or the C ity’s Worker s' Compensation
Division (WCD) .
2. Employees who receive medical treatment for an on- duty injury or illness must be cleared to return to
duty by the attending physician.
C. REPORTING INJURIES
1. Employees sustaining on -duty injuries, no matter how slight, should notify their immediate supervisor as
soon as possible and provide the information needed to document the injury.
2. Supervisors shall document the incident as follows:
a. Report of Industrial Injury (WC001) .
(1) The WC001 form shall be used, and the proper box check ed, indicating if medical treatment is
being or will be sought .
(2) The completed form(s) shall be uploaded to the City’s Workers’ Compensation portal. Contact
the PSD for the most up to date link.
(3) In more severe injury cases that cause lost time from work, o r where injuries require immediate
or emergency medical attention, the employee’ s supervisor shall complete the WC001 form as
soon as practical.
b. Employee's Claim for Workers' Compensation Benefits (DWC1) .
(1) A supervisor shall provide a DWC1 form to an employee within 24 hours of an on -duty injury
when any supervisor becomes aware of either of the following:
(a) An employee filing a Report of Industrial Injury or reporting an industrial injury or illness ; or
(b) The employee is seeking, or intends to seek, medical treatment .
(2) Failure to provide this form to the injured employee within the specified time frame may result in
a penalty to the city .
(3) Before giving the DWC1 form to the injured employee, the supervisor shall complete lines 9
through 18 on page 4 of the form.
(4) If the employee completes sections 1- 7 of the DWC1 form at the time the report is made, the
supervisor shall:
(a) Immediately upload the DWC1 form to the City’s Workers’ Compensation portal.
SACRAMENTO POLICE DEPARTMENT
GENERAL ORDERS
GO 254.01
Page 2 of 2
(b) Provide the employee with the “Medical Treatment Facilities for City Employees Injured at
Work” document found on the Department’s Automated Manual System (AMS).
(c) Provide the employee with the Duty Status Report (SPD 165) to bring to their medical
appointment. (See below ).
(5) If the employee does not complete the DWC1 at the time the report is made, the supervisor
shall give the employee the entire DWC1 Packet, (completed according to subsection (2)
above).
c. Duty Status Report (SPD 165) .
(1) An employee injured on duty and receiving medical treatment shall obtain a completed SPD
165 form from their treating physician.
(2) The SPD 165 form is required for each visit made to a doctor until the employee is released
from care by the treating physician.
(3) The employee shall submit the SPD 165 form to their immediate supervisor, or the on- duty
supervisor.
(4) Upon receipt of the SPD 165 form, the supervisor shall immediately upload a copy to the City’s
Workers’ Compensation portal.
(5) When serious/incapacitating i njuries requiring immediate hospitalization or doctor's care render
an employee unable to obtain a copy of an SPD 165 form, their immediate supervisor shall
ensure that a copy of this form is completed by the treating physician as soon as practical.
D. EMERGENCY CARE OF MAJOR MEDICAL TRAUMA, INJURY, OR ILLNESS
1. When ambulance transport is required for an on-duty illness/injury, the injured/ill employee shall be
consulted regarding choice of hospital.
2. In cases where the employee is not able to make a hospital preference known, the supervisor on the scene shall notify the Communications Shift Supervisor of the employee's name, badge number, and
where the employee was taken.
3. The employee’s supervisor will notify PSD immediately in the event an employee i s transported to a
hospital for medical care.
4. PSD will notify the city’s Risk Man agement Division and will remain in continuing communication with
the Risk Management Division until the employee is admitted to a hospital or treated and released.
5. If the employee is admitted to a hospital for treatment , the Risk M anagement Division will monitor the
employee’ s progress